This paper systematically reviewed and analyzed the recent publications of robotic-assisted surgeries in the field of tissue repair and reconstruction. Surgical robots can elevate skin flap more accurately and shorten the time of tissue harvest. In addition, robotic-assisted surgery has the advantage of minimal tissue trauma and thus forms minimal scar. The utilization of surgical robots reduces the occurrence of complications after oral radical tumor resection while achieving cosmetic sutures. Robotic-assisted radical mastectomy could radically remove invasive breast cancer lesions and achieve breast reconstruction in the first stage through the small incisions in the operation areas. Surgical robots enable precise microvascular anastomosis and reduce tissue edema in the surgical field. Robotic-assisted technology can help appropriately locate the target tissues at different angles during sinus and skull base surgeries and accurately place tissues during urethroplasty. The robotic-assisted technology provides a new platform for surgical innovation in the field of tissue repair and reconstruction. However, the uncertainty in the survival rate after tumor radical surgery, the increase of operating time, and the high costs are barriers for its clinical application in tissue repair and reconstructive surgery. Nevertheless, robotic-assisted technology has already demonstrated an impact on the field of tissue repair and reconstruction in a meaningful way.
Breast Neoplasms ; surgery ; Cicatrix ; prevention & control ; Humans ; Minimally Invasive Surgical Procedures ; methods ; trends ; Mouth Neoplasms ; surgery ; Operative Time ; Reconstructive Surgical Procedures ; methods ; trends ; Robotic Surgical Procedures ; methods ; trends ; Skull Base ; surgery ; Surgical Flaps ; Tissue and Organ Harvesting ; Urethra ; surgery

The goal of auricular cartilage harvest is to obtain a sufficient amount for reconstruction and to minimize the change in ear shape. The cartilage can be harvested by a posterior or anterior approach, and each method has advantages and disadvantages. The posterior approach presents the advantage of scar concealment, but there are limits to the amount of cymba cartilage that may be harvested. In contrast, the anterior approach may cause a noticeable scar. However, as cartilage is collected, the anterior approach provides a view that facilitates the preservation ear structure. In addition, it is possible to obtain a greater amount of cartilage. From January 2014 to December 2015, we harvested auricular cartilage graft material in 17 patients. To prevent the development of trapdoor scars or linear scar contracture, short incisions were made on the superior border of the cymba and cavum. Two small and narrow incisions were made, resulting in suboptimal exposure of the surgical site, which heightens the potential for damaging the cartilage when using existing tools. To minimize this, the authors used a newly invented ball-type elevator. All patients recovered without complications after surgery and reported satisfaction with the shape of the ear.
Autografts ; Cartilage* ; Cicatrix ; Contracture ; Ear ; Ear Cartilage ; Elevators and Escalators ; Humans ; Methods ; Tissue and Organ Harvesting ; Transplants

Kidney transplantation is the preferred treatment for eligible end-stage renal disease patients. However, the supply of donated kidneys has been consistently insufficient to meet the transplantation requirements of the population. In this paper, I discuss the feasibility of several policy options that engage potential donors or key individuals in a Singapore context, including financial and non-financial incentives for deceased/living organ donors and their families, improving actualisation rates of both donation after brain death, donation after cardiac death through quality improvement programmes and remuneration schemes, and a media platform for directed organ donation. I conclude by highlighting the most feasible policies to be considered.
Altruism ; Health Policy ; Humans ; Kidney ; surgery ; Kidney Failure, Chronic ; surgery ; Kidney Transplantation ; methods ; Living Donors ; Nephrectomy ; Quality Improvement ; Singapore ; Tissue Donors ; Tissue and Organ Harvesting ; Tissue and Organ Procurement

OBJECTIVETo investigate the trans-areola approach for costicartilage harvesting in order to avoid the obvious scar resulted by traditional approach through chest incision.

METHODSFrom 2013, 7 cases who underwent rhinoplasty received costicartilage harvesting through trans-areola approach. The incision was designed along the lower interior edge of right areola. Then the dissection was performed to expose the 5th costicartilage. Then a costicartilage, 2 - 5 cm in length, was harvested. The incision was closed delicately. The suture was removed 7 days after operation.

RESULTSThe patients were followed up for 3 months to 2 years without hypertrophic scar and breast deformity. The scar was located in conceal location. The satisfactory rate was higher than that in patients with chest incision.

CONCLUSIONSThe scar resulted from trans-areola approach is comparatively conceal, compared with that at chest.

Breast ; surgery ; Cicatrix ; pathology ; Costal Cartilage ; Dissection ; methods ; Female ; Follow-Up Studies ; Humans ; Nipples ; surgery ; Rhinoplasty ; methods ; Time Factors ; Tissue and Organ Harvesting ; methods ; Transplant Donor Site

Donor shortage is a major limitation in organ transplantation. Several studies have reported that extracorporeal membrane oxygenation (ECMO)-assisted organ donation can be successfully completed without inducing warm ischemia in patients with brain death. The present report described clinical experience of three patients (23-yr old man, 32-yr old man, and 41-yr old woman) who underwent ECMO for the evaluation of brain death and organ donation. They donated six kidneys, three livers, and one both lungs without warm ischemia by ECMO. Six kidney recipients successfully recovered normal status without hemodialysis and two liver recipients survived with normal liver functions, but one liver recipient and one lung recipient died 3 and 15 days after transplantation. Our report strongly encourages ECMO-assisted organ donation from brain death patients with refractory cardiopulmonary collapse to achieve improved organ transplantation.
Adult ; *Brain Death/diagnosis ; *Extracorporeal Membrane Oxygenation ; Female ; Heart Arrest ; Humans ; Male ; Middle Aged ; Organ Transplantation ; *Tissue Donors ; Tissue and Organ Harvesting ; Tissue and Organ Procurement/*methods ; Treatment Outcome ; Young Adult

The introduction of perforator flaps represented a significant advance in microsurgical reconstruction. However, confusion has developed due to the erroneous belief that perforator flaps are different from conventional flaps. The concept of the perforator is not new, but is an idea that evolved from the conventional flap. In fact, some of the flaps used by microsurgeons were perforator flaps. The only difference is the anatomical level of the blood vessels involved; the perforator concept is focused on the distal circulation, so-called 'perforator'. Therefore, thinner sections of tissue can be taken from the conventional donor sites of myocutaneous flaps. With the use of perforators, there are no longer "flap of choice" for specific reconstructions, because conventional donor sites have become universal donor sites, enabling the harvesting of a variety of flaps. Moreover, depending on the surgeon's ability, any flap can be utilized as a perforator-based island flap whose source vessel has been completely preserved. Therefore, tissues can be efficiently customized and tailored into any configuration required for reconstruction. The application of perforator flap technique enables more precise dissection, and allows more selective harvesting of thinner flaps, which will expand options in reconstructive surgery. No doubt the technique will continue to evolve.
Humans ; Perforator Flap/*blood supply/classification/trends ; Reconstructive Surgical Procedures/*methods ; Skin Transplantation/*methods ; Surgical Flaps/*blood supply ; Tissue and Organ Harvesting/*methods

A 34-yr-old female was diagnosed as being brain dead. Preoperative ultrasound revealed no abnormal focal lesions. However, the horseshoe kidney was identified during organ harvest. En bloc nephrectomy was performed. The kidney was divided at the midline of isthmus. The divided right kidney was discarded due to numerous arteries and veins. The divided left kidney was transplanted. After declamping, the kidney was well perfused and started clearing. Resistive index was 0.72. Glomerular filtration ratio was 84.69 mL/min on postoperative day 14. The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.
Adult ; Cadaver ; Female ; Humans ; Kidney/*abnormalities/ultrasonography ; Kidney Failure, Chronic/diagnosis/*therapy ; Kidney Transplantation/*methods ; *Tissue Donors ; Tissue and Organ Harvesting/*methods ; Treatment Outcome

A 34-yr-old female was diagnosed as being brain dead. Preoperative ultrasound revealed no abnormal focal lesions. However, the horseshoe kidney was identified during organ harvest. En bloc nephrectomy was performed. The kidney was divided at the midline of isthmus. The divided right kidney was discarded due to numerous arteries and veins. The divided left kidney was transplanted. After declamping, the kidney was well perfused and started clearing. Resistive index was 0.72. Glomerular filtration ratio was 84.69 mL/min on postoperative day 14. The horseshoe kidney can be successfully transplanted and could be a good solution for the shortage of organ donors.
Adult ; Cadaver ; Female ; Humans ; Kidney/*abnormalities/ultrasonography ; Kidney Failure, Chronic/diagnosis/*therapy ; Kidney Transplantation/*methods ; *Tissue Donors ; Tissue and Organ Harvesting/*methods ; Treatment Outcome

PURPOSE: To compare the clinical outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) with same-size grafts in patients with keratoconus. METHODS: Medical records of 16 eyes from 15 patients treated from June 2005 through April 2011 were retrospectively reviewed. Patients with contact lens intolerance or who were poor candidates for contact lens fitting due to advanced cone underwent keratoplasty. The transplantations consisted of 11 DALK and 5 PKP with same-size grafting for keratoconus. Best-corrected visual acuity (BCVA), refractive error, corneal topographic profiling, and clinical course were compared between DALK and PKP groups. RESULTS: The follow-up period was 30 +/- 17 months in the DALK group and 45 +/- 20 months in the PKP group (p = 0.145). At final follow-up, the DALK and PKP groups achieved a BCVA (logarithm of the minimum angle of resolution) of 0.34 and 0.52, respectively (p = 0.980). Postoperative refractive error and mean simulated keratometric index showed myopic astigmatism in both groups without any statistical difference. Corneal irregularity index measured at 5 mm in the DALK group was less than that of the PKP group at 1-year follow-up (p = 0.021); however, at final follow-up, there was no longer a statistically significant difference. Endothelial cell counts were lower in the PKP group than in the DALK group at final follow-up (p = 0.021). CONCLUSIONS: The optical outcomes of DALK with same-size grafts for keratoconus are comparable to those of PKP. Endothelial cell counts are more stable in DALK compared to PKP.
Adult ; Cornea/pathology/surgery ; Corneal Topography ; Female ; Follow-Up Studies ; Humans ; Keratoconus/pathology/physiopathology/*surgery ; Keratoplasty, Penetrating/*methods ; Male ; *Refraction, Ocular ; Retrospective Studies ; Time Factors ; Tissue and Organ Harvesting/*methods ; Treatment Outcome

Following a post-traumatic incident, orthopaedic surgeons often struggle to look for an abundant source of alternative bone graft because the bone defect is too big or when nonunion is refractory to treatment. We present two cases where the patients' bone grafts were harvested from the healthy femur. This process involved the use of a new intramedullary reamer, which allowed the bone graft to be harvested simultaneously during the reaming process.
Adult ; Bone Transplantation ; instrumentation ; methods ; Equipment Design ; Femur ; pathology ; Humans ; Male ; Middle Aged ; Therapeutic Irrigation ; Tissue and Organ Harvesting ; instrumentation ; methods